Envolve Center Leads Collaborative Effort to Reduce Impact of Social Determinants on Health

The influence of social determinants on health is a national and global issue. The World Health Organization defines social determinants of health as “the conditions in which people are born, grow, live, work, and age,” which in turn “are shaped by the distribution of money, power, and resources at global, national, and local levels.”

Centene Corporation and Envolve® seek to understand how life inequalities create barriers to access and care, an area of work that has now become a priority for the Envolve Center. The Envolve Center is leading cutting-edge research focused on supporting the health of vulnerable populations, with the forum serving as one of the Envolve Center’s leading efforts to develop multi-faceted solutions.

This forum served as a platform to engage many stakeholder groups who are working to tackle the issues impeding better healthcare. Award-winning journalist Nancy Cambria, who has written extensively on the impact of social determinants in St. Louis’ at-risk communities, delivered the keynote address, providing a human face to the statistics many know too well and emphasizing the differences individuals can make by understanding the stories of those in our communities.

An interdisciplinary panel discussion identified key factors to working more effectively across the spectrum of government, industry, academia, and communities to reduce the impact of social determinants on health. The panel was led by Michal Grinstein-Weiss, Founding Director of the Envolve Center for Health Behavior Change and Washington University Professor. Panelists included:

Mark Iwry, former Senior Advisor to the Secretary and Deputy Assistant Secretary for Retirement and Health Policy, U.S. Treasury, under the Clinton and Obama Administrations;

Mary McKay, Neidorff Family and Centene Corporation Dean, George Warren Brown School of Social Work at Washington University;

Jason Purnell, Associate Professor, Brown School, Washington University and Principal Investigator & Director, For the Sake of All

“This effort is unique because we often work in silos and are unaware of the strengths, opportunities and challenges that each sector brings to the table,” explained Grinstein-Weiss.

“The panel provided a forum for a dialogue to better understand each sector’s perspective and how we might work together to bring about effective change.” - Michal Grinstein-Weiss

Panel members shared hurdles they each encounter in developing solutions through their areas of expertise and repeatedly focused on the element of change. They called for change in the way research is conducted and disseminated, change in the way research is accepted and acted upon by government and healthcare agencies, and change in the way diverse stakeholders work together to create the best outcomes and availability of care to those in need. Achieving results will require this approach to be embodied by the healthcare industry, government, academia, advocacy groups, and other community organizations.

All three Washington University Brown School panelists – Michal Grinstein-Weiss, Dean Mary McKay, and Jason Purnell – also recognize the need for change.

Admittedly, speed is a challenge for the world of academia compared to the pace of other industries, said the panelists. The Brown School researchers agreed that the ways in which academics share and disseminate research need updating.

“The challenge to us as universities is, how do we create new knowledge, but (also) rapidly translate that, so that you can use it in government, you can use it in industry … you can use it in community partner research,” said Dean McKay.

Purnell agreed there needs to be improvement in how findings are communicated, but cautions against rushing research, noting it often takes justified time to collect the necessary information to properly impact policy and that the voice of vulnerable populations is key.

“There are some really important questions that before we hurry up and intervene, we have to ask the end user how we ought to design the intervention,” Purnell pointed out during the discussion of relaying results to policymakers.

McKay also suggested academia work differently to help develop more effective results. She recommended supporting a new type of academic: a professor who collaborates, working across disciplines, and creates studies and new solutions with “unnatural partners.”

These new approaches were strongly supported by Mark Iwry, a panelist who has an extensive background in the government and policy side of healthcare, including being part of the team that developed the federal Affordable Care Act (ACA).

Iwry stressed that improving communication between key players will ultimately improve healthcare. Specifically, he cited increasing this communication across sectors and providing better messaging of data results to translate into better policies. Iwry said research and findings must be provided to decision makers in a manner that is relatively easy to understand, and then put before voters in the same manner.

“Make the message simple. Make it something voters can understand. They have limited resources and time to educate themselves in the increasingly specialized data and understanding that one needs to have to approach policy intelligently and in an informed way,” explained Iwry. He said there is “little tolerance” in the legislative branch for complexity and uncertainly, so providing jargon-free, essential findings will yield the best policies. “Simple, decisive answers are what people go for.”

Iwry also pointed out that this collaboration of people and groups from very different backgrounds is crucial to reducing the impact of social determinants on health. This diverse partnership, spearheaded by the Envolve Center, is critical to recognizing and accounting for society’s differences and real-world factors, which Iwry hopes results in eliminating healthcare insensitivities and discrimination, and in turn leads to developing better solutions.

“Public policy and the actions we take as a society should not be driven by an easy assumption that we’re all alike. That we all have a similar experience,” stated Iwry. He reiterated that differences must be recognized and social determinants taken into account in deciding what we do as a society. He also points out that government does not always understand that. “Those kinds of differences, insensitivity, to these factors translate into very tangible differences in policy, and the differences in policy translate, for better or for worse, into very tangible differences in outcomes.”

Ultimately, the team at the Envolve Center – along with the support of the many stakeholder groups represented at this forum – hopes to use evidence-based science and strategic implementation to disrupt and improve the healthcare system. Research results will be used to determine what is working, what isn’t working, and what needs to change going forward to reduce the impact of social determinants and achieve health equity, one program at a time. This effort will require collaboration – the kind demonstrated at Social Determinants and Healthcare.

“This is possible to solve with good public policy, with good industry partners, with universities, with communities and our consumers at the Envolve Center," said Mckay.